Avery, James A

Avery, James A is an individual health care provider with primary practice located at 210 Wisconsin American Dr Suite #265, Fond Du Lac WI 54935-2999. He recently has only one registered license in Other Service Providers / Specialist, which is considered as his primary health care specialty. Avery, James A can be contacted via phone (920) 907-7400.

Contact Information

Primary practice address
210 Wisconsin American Dr Suite #265 Fond Du Lac WI 54935-2999
Phone: (920) 907-7400
Fax: (920) 907-7401
Website:
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Health care specialties

SpecialtyCodeLicense #State
Other Service Providers / Specialist 174400000X 24651-020 Wisconsin

Profile Details

NPI number 1750374096
LBN Legal business name Avery, James A
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Aug 23rd, 2005
Last updated Jun 13th, 2014 - about 11 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1750374096 NPPES
Wisconsin MEDICAID 30463800

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